Abstract
McFarland fractures represent a type of oblique medial malleolar fracture in children that can be challenging to diagnose and treat. A 14-year-old junior league soccer player with a Salter Harris type IV McFarland fracture presented late, as the initial routine two views radiological assessment failed to reveal a clear fracture line. The addition of a mortise ankle view led to the correct diagnosis and subsequent MRI findings guided nonsurgical treatment with an excellent outcome. The debate between obtaining two or three views in closed pediatric ankle injuries according to the so-called Ottawa rules and the usefulness of magnetic resonance imaging (MRI) in the decision making for the choice of treatment of McFarland fractures are discussed in this case report.
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References
Kling Jr TF. Operative treatment of ankle fractures in children. Orthop Clin North Am. 1990;21(2):381–92.
McFarland B. Traumatic arrest of epiphyseal growth of the lower end of tibia. Br J Surg;1931:78–82
Gleizes V, Glorion C, Langlais J, Pouliquen JC. McFarland fractures. A series of 24 cases. Rev Chir Orthop Reparatrice Appar Mot. 2000;86(4):373–80.
Camilleri JP, Leroux J, Bourelle S, Vanel O, Cottalorda J. [Mc Farland fractures: a retrospective study of 26 cases]. Rev Chir Orthop Reparatrice Appar Mot. 2005;91(6):551–7.
Duran JA, Dayer R, Kaelin A, Ceroni D. Intraoperative arthrography for the evaluation of closed reduction and percutaneous fixation of displaced McFarland fractures: an alternative to open surgery. J Pediatr Orthop. 2011;31(1):e1–5.
Blackburn EW, Aronsson DD, Rubright JH, Lisle JW. Ankle fractures in children. J Bone Joint Surg Am. 2012;94(13):1234–44.
Cottalorda J, Béranger V, Louahem D, Camilleri JP, Launay F, Diméglio A, et al. Salter-Harris Type III and IV medial malleolar fractures: growth arrest: is it a fate? A retrospective study of 48 cases with open reduction. J Pediatr Orthop. 2008;28:652–5.
Clark KD, Tanner S. Evaluation of the Ottawa ankle rules in children. Pediatr Emerg Care. 2003;19(2):73–8.
Dowling SK, Wishart I. Use of the Ottawa ankle rules in children: a survey of physicians’ practice patterns. CJEM. 2011;13(5):333–8. E44–6.
Tandeter HB, Shvartzman P. Acute ankle injuries: clinical decision rules for radiographs. Am Fam Physician. 1997;55(8):2721–8.
Wallis MG. Are three views necessary to examine acute ankle injuries? Clin Radiol. 1990;41(3):218.
Letts RM. The hidden adolescent ankle fracture. J Pediatr Orthop. 1982;2(2):161–4.
Hübner U, Schlicht W, Outzen S, Barthel M, Halsband H. Ultrasound in the diagnosis of fractures in children. J Bone Joint Surg Br. 2000;82(8):1170–3.
Brandser EA, Berbaum KS, Dorfman DD, Braksiek RJ, El-Khoury GY, Saltzman CL, et al. Contribution of individual projections alone and in combination for radiographic detection of ankle fractures. AJR Am J Roentgenol. 2000;174(6):1691–7.
Vargish T, Clarke WR, Young RA, Jensen A. The ankle injury–indications for the selective use of X-rays. Injury. 1983;14:507–12.
Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992;21(4):384–90.
Pigman EC, Klug RK, Sanford S, Jolly BT. Evaluation of the Ottawa clinical decision rules for the use of radiography in acute ankle and midfoot injuries in the emergency department: an independent site assessment. Ann Emerg Med. 1994;24(1):41–5.
Boutis K, Schuh S. Prospective validation and head-to-head comparison of 3 ankle rules in a pediatric population. Ann Emerg Med. 2010;55(4):391–2.
Myers A, Canty K, Nelson T. Are the Ottawa ankle rules helpful in ruling out the need for x ray examination in children? Arch Dis Child. 2005;90(12):1309–11.
Dowling S, Spooner CH, Liang Y, Dryden DM, Friesen C, Klassen TP, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med. 2009;16(4):277–87.
Boutis K, Komar L, Jaramillo D, Babyn P, Alman B, Snyder B, et al. Sensitivity of a clinical examination to predict need for radiography in children with ankle injuries: a prospective study. Lancet. 2001;358(9299):2118–21.
Petscavage J, Baker SR, Clarkin K, Luk L. Overuse of concomitant foot radiographic series in patients sustaining minor ankle injuries. Emerg Radiol. 2010;17(4):261–5.
Cockshott WP, Jenkin JK, Pui M. Limiting the use of routine radiography for acute ankle injuries. Can Med Assoc J. 1983;129:129–31.
Vangsness Jr CT, Carter V, Hunt T, Kerr R, Newton E. Radiographic diagnosis of ankle fractures: are three views necessary? Foot Ankle Int. 1994;15:172–4.
Brage ME, Rockett M, Vraney R, Anderson R, Toledano A. Ankle fracture classification: a comparison of reliability of three X-ray views versus two. Foot Ankle Int. 1998;19(8):555–62.
Devalentine SJ. Epiphyseal injuries of the foot and ankle. Clin Podiatr Med Surg. 1987;4(1):279–310.
De Sanctis N, Della Corte S, Pempinello C. Distal tibial and fibular epiphyseal fractures in children: prognostic criteria and long-term results in 158 patients. J Pediatr Orthop Part B. 2000;9:40Y44.
Mouterde P, Rigault P, Padovani JP, Finidori G. [Traumatic injuries of the epiphyseal plate in the lower extremity of the tibia]. Chir Pediatr. 1979;20(2):115–23.
Nenopoulos SP, Papavasiliou VA, Papavasiliou AV. Outcome of physeal and epiphyseal injuries of the distal tibia with intra-articular involvement. J Pediatr Orthop. 2005;25(4):518–22.
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Symeonidis, P.D., Konstantinidis, G.A., Dionellis, P.S. et al. Late diagnosis of a McFarland fracture: imaging and treatment. Skeletal Radiol 43, 65–69 (2014). https://doi.org/10.1007/s00256-013-1680-x
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DOI: https://doi.org/10.1007/s00256-013-1680-x